Entity Details

Basic

Entity Type:
Free Standing NF/SNF (Free Standing NF/SNF)

Medicaid #:
0801548

CCN #:
165191

Occupancy Type:
Beds

Max Occupancy:
64

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
690391

Initial License Date:
10/28/1964

Current License Date:
04/21/2025

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
04/21/2026

Months Since Last Survey:
11

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:
05/18/2022

Loss of NA Training Expires:
05/17/2024

Contact

Address:
201 Alix Avenue

City:
Red Oak

State:
Iowa

Zip:
51566-1001

Phone:
(712) 623-3170

Fax:
(712) 623-3151

URL:

Administrator/License #:
Mike Early / 077950

Administrator Email:
mearly@good-sam.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: